Presentation
Photos of initial, six-week and 12-week presentations demonstrate a relative decrease in the tendon volume. [podiatrytoday.com]
At present, there are many theories that have sought to explain the origin of the pain. [fifamedicalnetwork.com]
Differential Diagnosis Specific differential diagnoses to consider when patients present with ‘tendinopathy’ at various anatomical regions. [physio-pedia.com]
None of the methods presented had particularly awe-inspiring results, and there are numerous other potential treatments backed by equivocal evidence that could have been included in the debate. [runnersworld.com]
In one retrospective case series, 29% of patients who presented with symptoms of less than six months’ duration were eventually referred for surgery. [cmaj.ca]
Entire Body System
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Burning Pain
This causes burning pain in addition to reduced flexibility and range of motion While tendinopathy can affect any tendon, it’s more common in the: Achilles tendon rotator cuff tendons patellar tendon hamstring tendons Read on to learn more about tendinopathy [healthline.com]
Cardiovascular
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Hypertension
For patients unsuitable for oral NSAIDs, for example patients with coexistent hypertension and chronic kidney disease, topical NSAID gels can be effective. [bjgp.org]
Musculoskeletal
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Myofascial Trigger Point
trigger points in the soleus, 17 and these trigger points give referred pain to the Achilles tendon area. 17 Thus, relaxing the calf muscles to improve healing in the damaged Achilles tendon might make sense. [journals.sagepub.com]
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Osteophyte
The formation of excess calcium deposits—bony growths called bone spurs or osteophytes—on the bones of shoulder can similarly lead to friction and crowding, which can irritate or tear a tendon. [coastalorthoteam.com]
Workup
Further workup with MRI is also an option to rule out other pathology or determine the severity of the tendinosis. However, it often does not impact the initial treatment. Accordingly, one should reserve MRI for recalcitrant cases. [podiatrytoday.com]
Workup In patients with biceps tendinopathy, plain radiography may show calcifications in the biceps tendon or demonstrate associated degeneration in the glenohumeral or acromioclavicular joint. [emedicine.medscape.com]
Treatment
Surgical treatment is preferred for chronic and recurring ruptures. [ebm-guidelines.com]
A systematic review of the use of platelet-rich plasma in sports medicine as a new treatment for tendon and ligament injuries. (2011) This article reviews multiple publications regarding the role of Platelet-rich plasma in treatment of tendon and ligament [prolotherapy.com]
Furthermore, there is currently no strong evidence for second-line treatments such as shockwave therapy and platelet-rich plasma. Therefore, it is important to improve exercise protocols as a first treatment of choice. [clinicaltrials.gov]
Heavy-load eccentric calf muscle training for the treatment of chronic achilles tendinosis. Am J Sports Med. 1998;26(3):360-366. Visnes H, Bahr R. [fifamedicalnetwork.com]
Prognosis
Reactive Tendinopathy Normal tissue adaptation phase Prognosis: Excellent. Normal Recovery! 2. Tendon Dysrepair Injury rate Repair rate Prognosis: Good. The tendon tissue is attempting to heal. [physioworks.com.au]
Reactive Tendinopathy Normal tissue adaptation response to decrease stress Acute pain with thickened tendon due to swelling Prognosis: Excellent 2. Tendon Dysrepair Injury rate exceeds Repair rate Prognosis: Good. [rehab2perform.com]
What is the prognosis? Although tendinopathy may seem like relatively benign soft tissue pathology, recovery often follows a prolonged time course, even with ideal treatment. [cmaj.ca]
Long-term prognosis of patients with achilles tendinopathy. An observational 8-year follow-up study. Am J Sports Med 2000;28(5):634-42. «PMID: 11032217» PubMed [ebm-guidelines.com]
[…] tendon (a commonly affected tendon) Specialty Primary care Symptoms Pain, swelling [3] Causes Injury, repetitive activities [3] Diagnostic method Based on symptoms, examination, medical imaging [4] Treatment Rest, NSAIDs, splinting, physiotherapy [5] Prognosis [en.wikipedia.org]
Etiology
Etiology Overuse or overload injury (repetitive, excessive strain), degeneration Skeletal abnormalities with strain on tendons (e.g., genu varum ) Acute trauma (laceration, rupture) Risk factors Occupation: athletes, jobs requiring manual labor or repetitive [amboss.com]
Three etiologies of tendinopathy have been described, as follows [14] : Mechanical theory - This theory states that repetitive loading of the tendon results in microscopic degeneration. Fibroplasia occurs within the tendon, resulting in scar tissue. [emedicine.medscape.com]
However, a low metabolic rate results in slow healing after injury. [6] Epidemiology /Etiology Tendinopathic tendons have an increased rate of matrix remodeling, leading to a mechanically less stable tendon that is probably more susceptible to damage. [physio-pedia.com]
Table 1: Classification of disorders of the Achilles tendon, with typical findings 3, 4 The high prevalence among runners points to mechanical loading as an important etiologic factor. 2 In vitro and in vivo research suggests that periods of mechanical [cmaj.ca]
Nho SJ, Yadav H, Shindle M, MacGillivray JD, Rotator cuff degeneration: etiology and pathogenesis. Am J Sports Med 2008; 36:987-993. Kuhn JE, Dunn WR, Sanders R, An Q, Baumgarten KM, Bishop JY et al. [aspetar.com]
Epidemiology
Epidemiology References: [1] Epidemiological data refers to the US, unless otherwise specified. [amboss.com]
EPIDEMIOLOGY As tendinopathy is degenerative and cumulative, it rarely occurs in players younger than 18 years old. [aspetar.com]
Epidemiology of tendon problems in sport. In: Maffulli N, Renström P, Leadbetter W, eds. Tendon injuries: Basic science and clinical medicine. London: Springer-Verlag London Limited. Cook JL, Khan KM, Purdam C. Achilles tendinopathy. [fifamedicalnetwork.com]
"Epidemiology of rotator cuff tendinopathy: a systematic review". Shoulder & Elbow. 5 (4): 256–265. doi : 10.1111/sae.12028. ISSN 1758-5740. "Inflammation". The Free Dictionary. "avascular". The Free Dictionary. Rees, J. [en.wikipedia.org]
Related Medscape Reference topic: Tenosynovitis Epidemiology Frequency United States Biceps tendinopathy is a common condition, but the exact frequency is unknown. Raney EB, Thankam FG, Dilisio MF, Agrawal DK. [emedicine.medscape.com]
Pathophysiology
The pathophysiology of tendinopathy is yet to full elucidated but one popular theory is the continuum model with inflammation rather than degeneration implicated 2,3 : reactive tendinopathy tendon dysrepair (also known as "failed healing") degenerative [radiopaedia.org]
sudden increase in exercise intensity, inadequate rest, hard/uneven training grounds, ill-fitting /inappropriate footwear) Previous tendon injuries Recent use of fluoroquinolones References: [1] Pathophysiology Unlike in cases of tendinitis or tenosynovitis [amboss.com]
The Pain of Tendinopathy: Physiological or Pathophysiological. Sports Med 2014. 44:9-23. 4 Scott A, Docking S, Vicenzino B, et al. [acatoday.org]
"Enthesitis: from pathophysiology to treatment". Nature Reviews Rheumatology (Review). 13 (12): 731–741. doi : 10.1038/nrrheum.2017.188. PMID 29158573. Schmitt, SK (June 2017). "Reactive Arthritis". [en.wikipedia.org]
[…] structure through tenolysis) is rarely necessary but may be required in refractory cases. [7, 8, 9, 10, 11] Related Medscape Reference topics: Bicipital Tendon Injuries Bicipital Tendonitis Elbow and Forearm Overuse Injuries Shoulder Impingement Syndrome Pathophysiology [emedicine.medscape.com]
Prevention
Making sure to perform a proper warm-up and including enough cross-training is also helpful to prevent tendon overuse injuries. [verywellhealth.com]
This will prevent stiffness in your joint. As the pain goes away, continue range-of-motion exercises and add other exercises to strengthen the muscles around your joint. [healthy.kaiserpermanente.org]
It will also help you prevent future injuries. [uvahealth.com]